Pericardial decompression syndrome is a rare but potentially fatal complication following needle or surgical pericardiocentesis and should be recognized as paradoxical hemodynamic deterioration. The exact pathophysiology of pericardial decompression syndrome is unknown but is likely that several mechanisms involving hemodynamic, ischemic and autonomic imbalance lead to the clinical manifestation of this entity. There is no specific treatment for pericardial decompression syndrome other than supportive care, however, early interventions such as aggressive heart failure therapy, inotropic medications and sometimes mechanical circulatory support should be implement as mortality can be as high as 30%. We report a patient presenting with severe right ventricular failure and cardiogenic shock secondary to PDS.
For nearly all organisms, dispersal is a fundamental life history trait that can shape their ecology and evolution. Variation in dispersal capabilities within a species exists and can influence population genetic structure and ecological interactions. In fungus-gardening (attine) ants, co-dispersal of ants and mutualistic fungi is crucial to the success of this obligate symbiosis. Female-biased dispersal (and gene flow) may be favored in attines because virgin queens carry the responsibility of dispersing the fungi, but a paucity of research has made this conclusion difficult. Here, we investigate dispersal of the fungus-gardening ant Trachymyrmex septentrionalis using a combination of maternally- (mitochondrial DNA) and biparentally-inherited (microsatellites) markers. We found three distinct, spatially isolated mitochondrial DNA haplotypes. Two were found in the Florida panhandle and the other was found in the Florida peninsula. In contrast, biparental markers illustrated significant gene flow across this region and minimal spatial structure. The differential patterns uncovered from mitochondrial DNA and microsatellite markers suggest that most long-distance ant dispersal is male-biased and that females (and concomitantly the fungus) have more limited dispersal capabilities. Consequently, the limited female dispersal is likely an important bottleneck for the fungal symbiont. This bottleneck could slow fungal genetic diversification, which has significant implications for both ant hosts and fungal symbionts regarding population genetics, species distributions, adaptive responses to environmental change, and coevolutionary patterns.
Active volcanoes in Antarctica, in contrast to the rest of the icy landscape, have remarkable temperature and geochemical gradients that could select for a wide variety of microbial adaptive mechanisms and metabolic pathways. Deception Island is a stratovolcano flooded by the sea, resulting in contrasting ecosystems such as permanent glaciers (<0 oC) and active fumaroles (up to 100 oC). Steep gradients in temperature, salinity and geochemistry over very short distances have been reported for Deception Island, and have been shown to effect microbial community structure and diversity. However, little is known regarding how these gradients affect ecosystem functioning, for example due to inhibition of key metabolic enzymes or pathways. In this study, we used shotgun metagenomics and metagenome-assembled genomes to explore how microbial functional diversity is shaped by extreme geochemical, salinity and temperature gradients in fumarole and glacier sediments. We observed that microbial communities from a 98 oC fumarole harbor specific hyperthermophilic molecular strategies, as well as reductive and autotrophic pathways, while those from <80 oC fumaroles possess more diverse metabolic and survival strategies capable of responding to fluctuating redox and temperature conditions. In contrast, glacier communities showed less diverse metabolic potentials, comprising mainly heterotrophic and carbon pathways. Through the reconstruction of genomes, we were able to clarify putative novel lifestyles of underrepresented taxonomic groups, especially those related to Nanoarchaeota and thermophilic ammonia-oxidizing archaeal lineages. Our results enhance understanding of the metabolic and survival capabilities of different extremophilic lineages of Bacteria and Archaea.
In this study, we proposed an alternative analytical procedure for appraising the fugacity coefficient for gases using second virial coefficient with Lennard-Jones (12-6) potential. The present research is more efficient for determining of the fugacity coefficient of gases in wide ranges temperature and pressure ranges and related thermodynamic properties which is the novelty of this study. The fugacity coefficient for gases , , and has calculated in the temperature range from 30 K to 1000 K and pressure range from 0.1 atm to 200 atm by using the obtained analytical formula. To our knowledge, this work offers the first approximation to the evaluation of the fugacity coefficient for gases for and by second virial coefficients. The results obtained using the analytical formula of the fugacity coefficient is in good agreement with literature.
Objective We aimed to investigate DNA damage level and new potential biomarkers that can assist the diagnosis and treatment of congenital hearing loss. Design A prospective, non‐randomized study. Setting Canakkale Onsekiz Mart University, Canakkale, Turkey Participants We included a patient group consisting of 17 patients with congenital hearing loss and a control group consisting of 17 healthy individuals. Main outcome measures We applied the brainstem-evoked response audiometry (BERA) tests to determine the hearing loss. After taking blood samples, we applied cytokinesis-block micronucleus cytome (CBMN) assay. Methods After the demographic characteristics, family stories and Brainstem Evoked Response Audiometry results of both groups were obtained, their blood was taken. The cytokinesis-blocked micronucleus assay technique was applied to the blood samples to measure the frequency of micronucleus, nucleoplasmic bridge, and nuclear bud in both groups. Results We observed that the micronucleus, nucleoplasmic bridge, and nuclear bud frequencies were found to be significantly higher in hearing loss patients than the control group (p<0.0001). Also, we observed that the frequency of micronucleus in hearing loss patient was positively correlated with nuclear bud, which may indicate a common mechanism for these endpoints. Conclusion It was, for the first time, demonstrated that micronucleation, nucleoplasmic bridge, and nuclear bud formation were found to be higher, which is an indication of genomic instability in patients with congenital hearing loss. Since the markers we evaluated were linked with crucial diseases, our findings might suggest that patients are susceptible to many crucial diseases, including cancer.
The infrahyoid musculocutaneous flap (IHMCF) is a good alternative in the reconstruction of moderate-sized oral cavity surgical defects. Insufficient venous drainage can significantly affect the survival rate of this flap. Objectives Indentify the survival rates of the IHMCF and evaluate the functional capacity of reonstructed patients. Design We report a case series. Setting This study took place at the department of Head and Neck surgery of Oncology Hospital Ho Chi Minh City, the largest oncology center in South Vietnam. Participants We have 112 patients with defects after oral cavity resection for cancer that underwent IHMCF reconstruction from November 2013 to November 2018. In the raising of the flap, our technical approach specifically attempts to preserve more secondary veins for IHMCF. Main outcome measures Postoperative vitality of the flap was checked by clinical observation. The last examination was performed at 1 month after reconstructive operation. The functional capacity of our patients was evaluated by three doctors (head and neck surgeon, radiation oncologist, physiatrist) with understandability of speech scale and the functional oral intake score items. Results Two cases of partial skin necrosis (1.8%) were experienced. The majority of patients demonstrate favorable functional rehabilitation at long-term follow up. Conclusions. The IHMCF is a reliable flap suitable for medium-sized defects of the oral cavity. Altering the surgical approach to specifically preserve more venous outflow can improve the survival rate of the flap. Key words: infrahyoid musculocutaneous flap oral cavity defect
Aims: During the last two decades, new treatment methods have been developed for the surgical removal of second branchial cysts which result in less visible scars. The aim of this systematic review is to assess which surgical technique for second branchial arch cyst removal results in the lowest complication and recurrence rates with the highest scar satisfaction. Methods: Two authors systematically reviewed literature in the Cochrane, PubMed and EMBASE databases (search date: 1975 to December 23th, 2019) to identify studies comparing surgical outcomes of second branchial arch cyst removal. Authors appraised selected studies on directness of evidence and risk of bias. Results are reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Results: Out of the 2101 retrieved articles, four articles were included in the current review including a total of 140 operated cysts. Only two studies included pre-operatively infected cysts. Follow up ranged from 3 to 24 months. Complication rates ranged between 0 to 27.3% (conventional: [0-10.4%]; endoscopic/retro auricular: [0-27.3%]). None of the patients presented with postoperative recurrence. Significantly higher scar satisfaction was found in adult patients who underwent endoscopic or retro-auricular hairline incision cyst removal. Conclusion: No recurrence of disease occurred during (at least) 3 months of follow up using either conventional surgery or endoscopic/retro auricular techniques. Although more (temporary) complications occur using endoscopic and retro-auricular techniques, patients report a significantly higher scar satisfaction 3 to 6 months after surgery in comparison to the conventional technique. Future studies are needed to support these findings.
Introduction Sudden sensorineural hearing loss (SSNHL) management is controversial. Systemic steroids as treatment is the most recommended. British society of otology advised caution when prescribing systemic steroids during COVID-19 crisis. As a result, intratympanic steroids (ITS), seem to offer an alternative. Methods: Number of performed MRI scans for investigation of SSNHL between 01/01/2019 and 31/12/2019. This was used as a surrogate measure, reflecting the number of patients with SSNHL over that 12 months period. All patients who were diagnosed and treated for SSNHL between the 16th of March 2020 and the 8th of July 2020 were included in this study. Clinical outcomes included time interval between onset of SSNHL and start of treatment, response to treatment and side effects Results: In 2019, only 10 scan s for SSNHL were done. Twelve patients presented with SSNHL during 4 months of COVID-19 crisis (16 weeks). Three patients had dead ear on presentation with almost no response to steroids. Conclusion The prevalence of SSNHL in time of COVID-19 pandemic appears to be higher than that before the pandemic. ITS appears to be a safe, feasible and relatively effective method of SSNHL treatment during COVID-19 pandemic. Shared decision-making with the patient is central to any intervention, especially with lack of robust evidence.
Background: Specific details about cardiovascular complications, especially arrhythmias, related to COVID-19 are not well described. Objective: We sought to evaluate the incidence and predictive factors of cardiovascular complications and new-onset arrhythmias in Black and White hospitalized COVID-19 patients and determine the impact of new-onset arrhythmia on outcomes. Methods: We collected and analyzed baseline demographic and clinical data from COVID-19 patients hospitalized at the Tulane Medical Center in New Orleans, Louisiana, between March 1st and May 1st, 2020. Results: Among 310 hospitalized COVID-19 patients, the mean age was 61.4 ± 16.5 years, with 58,7% females, and 67% Black patients. Black patients were more likely to be younger, have diabetes and obesity . The incidence of cardiac complications was 20%, with 9% of patients having new-onset arrhythmia. There was no significant difference in cardiovascular outcomes between Black and White patients. D-dimer levels positively correlated with cardiac and new-onset arrhythmic event . New onset atrial arrhythmias predicted in-hospital mortality (OR=2.99 95% CI [1.35;6.63], p=0.007), a longer intensive care unit length of stay (mean of 6.14 days, 95% CI [2.51;9.77], p=0.001) and mechanical ventilation duration(mean of 9.08 days, 95% CI [3.75;14.40], p=0.001). Conclusion: Our results indicate that new onset atrial arrhythmias are commonly encountered in COVID-19 patients and can predict in-hospital mortality. Early elevation in D-dimer in COVID-19 patients is a significant predictor of new onset arrhythmias. Our finding suggest continuous rhythm monitoring should be adopted in this patient population during hospitalization to better risk stratify hospitalized patients and prompt earlier intervention.
This study presents a novel model to predict gas-water two-phase transport behaviors in shale microfractures by incorporating a mobile water film with varying thickness according to the extended Derjaguin-Landau-Verwey-Overbeek (DLVO) theory as well as multiple fluid transport mechanisms (i.e., real gas transport controlled by the Knudsen number and water slippage). This model is implemented in real shale microfractures via digital-core imaging. A gas-water displacement process is modelled by the invasion percolation theory, while a local multiphase distribution is determined by combining disjoining pressure with capillary force. Key findings reveal that gas relative permeability (RP) decreases by 17% and water RP enhances by 33.5%, when the mean aperture decreases from 1.67 to 0.0418μm. Neglecting water film brings a decrease in water RP and an overestimation of gas transport ability. Moreover, two critical microfracture apertures are determined, which enhances an understanding of the water film impact on gas-water transport properties in application.
Medullary thyroid carcinoma (MTC) typically manifests as a solitary thyroid nodule, and a miliary pattern on conventional chest imaging is not commonly observed. Here, we report a 58-year-old woman with constitutional symptoms, and innumerable small nodules on chest imaging, mimicking miliary tuberculosis. Pathologic findings confirmed a diagnosis of metastatic MTC.
Calciphylaxis creates a challenge in anticoagulation therapy for patients with mechanical heart valves and ESRD as warfarin cannot be used. We describe our approach in using enoxaparin as an alternative for anticoagulation in a patient with a mechanical heart valve and ESRD who developed calciphylaxis from warfarin.
Here, an 8-year-old girl is reported with bilateral horizontal gaze palsy, ataxia and drowsiness. Brain MRI demonstrated dorsal midbrain, bilateral putamen nuclei and cerebellar dentate nucleus involvement. MRS revealed an elevated lactate peak which suggested a mitochondrial disease. Finally, the molecular genetic test reported NDUFS4 gene mutation
Management of idiopathic ventricular fibrillation (IVF) is challenging because arrhythmic substrate may be missed; therefore, careful follow-up and reassessment are necessary. Three-dimensional mapping would be useful for reassessment of IVF because it revealed an arrhythmic substrate in a patient, 12 years after his initial diagnosis of IVF.
Understanding the dynamics of small populations is critical to conserve those species at most risk. Previous work has identified demographic and environmental factors that can mutually reinforce one-another to drive populations rapidly to extinction – a process known as the ‘extinction vortex.’ However, studies investigating robustness to the extinction vortex in relation to life history and ecological traits have been lacking. Here, we assemble a database of 55 vertebrate populations monitored to extirpation and perform three analyses to investigate whether a key fitness-related phenotypic trait – body size – influences the rate at which populations succumb to the extinction vortex. We find evidence that populations of smaller-bodied species deteriorate at a faster rate, suggesting that intrinsic biological traits can alter the susceptibility of species to the extinction vortex, and may serve as a useful feature for prioritizing which populations to invest conservation effort in.
Halophyte agriculture in marginal soils using saline water offers a sustainable solution for generating biomass feedstock for carbon-neutral aviation biofuels. A full-scale sustainable energy and agriculture system (SEAS) demonstration is planned for the Abu Dhabi coast, where evaporitic gypsiferous soils pose a challenge to long-term operation because of the potential for land degradation. In this study, geochemical modelling on the Geochemist’s Work Bench (GWB®) platform was employed to: (1) Evaluate the feasibility of using coastal groundwater versus seawater as irrigation feedwater; (2) determine the change in agricultural return water salinity through site-specific soils upon different seawater irrigation rates; and, (3) assess mineral deposition effects in the soil column as a function of site-specific soil characteristics at candidate sites over a one-year period of continuous seawater irrigation. Evaporation modelling was used to evaluate potential feedwater sources while varying feedwater composition and electrolyte activity coefficient models. 1-D saturated-flow advection-precipitation/dissolution modelling was utilized to assess return water quality and mineral deposition as a function of both the electrolyte activity coefficient model and the mineral composition of site-specific soils. Results pointed to seawater as the more viable feedwater option compared to coastal groundwater because of slower onset of precipitation. This effort demonstrated that soil type did not influence agricultural return water salinity (except for strongly gypsic soils) but influenced mineral precipitation under surficial evaporation conditions. Porosity loss correlated with layers of mineral deposition. The study points to the need for careful selection of land and saline water resources for the sustainable farming of halophytes.
Rationale, aims and objectives: A considerable amount of primary health care (PHC) clients comes in with medically unexplained complaints, leading to frequent consultations and high usage of services and health care costs. This study aimed to determine the prevalence of somatic symptom disorder among PHC attendees and to explore its relation with other mental disorders and risk factors. Methods: A cross sectional design was used to interview 400 attendees at five PHC centers in Nablus district, during Sept to Dec, 2019. Men and women age over 18 years old, without psychiatric diagnosis were invited to participate in the study. The Somatization scale of the Four-Dimensional Symptom Questionnaire was used to assess somatic symptom disorders. It is a valid tool to be used in PHC setting. Chi-squared test and multivariable logistic regression were used to explore determinant variables. Results: A high prevalence of somatic symptom disorder was seen in the sample [32.5% (95%CI= 27.9%-37.1%)]. The most prevalent symptoms were painful muscles (61.5%) followed by back pain (52.3%). Somatic symptom disorder was found to be associated with: Female gender [P =0.015 adjusted OR = 2.2 (95% CI= 1.3-4)], chronic diseases [P =0.027 adjusted OR = 2 (95%CI=1.1-3.6)], depression [P <0.001 adjusted OR = 3.2 (95%CI= 2.0-5.3)], and anxiety [P=0.032 adjusted OR = 3.0 (95%CI= 1.6-5.5)]. Additionally, attendees with high somatization were found to have significantly higher frequency of doctors visit [P=0.005 adjusted OR = 2.2 (95%CI= 1.3-4.0)] Conclusions: The prevalence of somatization among PHC attendees in Palestine is high. It is significantly higher among females, patients with chronic diseases, clients with anxiety and depressive disorders and patients with frequent doctors’ visits. Painful muscles and back pain are the most common symptom presented by patients, and this could be used initially by PHC physicians as a signal to consider for screening.